HIV derma complications: persistent pain which needs ‘mindfulness'

By Artika Bansal

New Delhi:At a time when there is no cure for the human immunodeficiency virus (HIV), antiretroviral therapy has made it a manageable disease. However, if HIV is not treated it can lead to more serious later-stage-acquired immunodeficiency syndrome (AIDS). In between the management and treatment, over time, HIV weakens the immune system and makes it hard to fight infections and diseases. Skin reactions are one such set of complications the patients goes through.

Skin conditions are said to be among the earliest signs of HIV and may also indicate the disease's progression. While some of these skin infections are called opportunistic infections as they take advantage of the weakened immune system of the infected person, there are some that result from an overactive immune system in response to antiretroviral therapy or as a side effect of the medications. Experts suggest managing these acute skin conditions by maintaining immunity and viral load within normal limits while ensuring compliance to antiretroviral therapy is the key.

Dermatological complications with HIV-infection

Dermatological conditions are common in HIV-infected people. According to the World Health Organisation (WHO), as the CD4 count decreases, the prevalence, spectrum and severity of skin conditions increases. Although not a major cause of mortality, skin and mucosal conditions can be a source of severe morbidity that provoke scratching, disfigurement, sleep disturbance, and psychological stress.

Speaking to ETHealthworld on the skin infections in HIV infected, Dr Neha Rastogi, Consultant-Infectious Diseases, Fortis Hospital, Shalimar Bagh, said, “Skin conditions related to HIV infections are broadly categorised into infectious, inflammatory, neoplastic, and mucosal causes. Some of these conditions occur at specific stages of HIV infection, which reflect the progression of the condition as they affect the immune system with direct and indirect skin aftereffects.” The skin reactions among infectious diseases include herpes virus, molluscum contagious infections, and fungal infections. Among cancerous, kaposi sarcoma is a characteristic pathology. Psoriasis and seborrheic dermatitis are also commonly associated conditions.

Herpes virus is the most common in people with HIV/AIDS. Caused by the same virus as chickenpox, herpes causes an outbreak of sores, blisters on the body, and can be treated with antiviral medications. Molluscum contagiosum is a highly contagious viral skin infection. In molluscum, there are bumps on the skin which are painless and harmless but require proper medical attention. Kaposi sarcoma is a type of skin cancer that causes patches of skin lesions. When an individual with HIV develops kaposi sarcoma, the diagnosis changes to AIDS. This condition responds to antiretroviral therapy and chemotherapy. Seborrheic dermatitis is a skin condition that causes patches of scaly skin, swelling, and itching on the person’s hairline and nasolabial folds. It is common in people with immune dysfunction. Other possible skin infections include folliculitis, warts, photodermatitis, prurigo nodularis, melanoma, shingles etc.

The three stages of HIV are acute HIV infection, chronic HIV infection, and AIDS. A person is most likely to experience skin conditions during stage 1 and stage 3 of HIV. Opportunistic infections are the most common in stage 3 of the infection. Elucidating on the progression of skin conditions in HIV stages, Dr Dipu TS, Associate Professor, Division of Infectious Diseases, Amrita Hospital, Kochi, said, “In the first stage of acute HIV, the virus reproduces rapidly in the body, causing severe flu-like symptoms, and it may be associated with transient rashes over the body. In the second stage of chronic HIV, the virus reproduces more slowly, causing the person to not feel any symptoms so no typical skin infections are seen during this stage. In the third stage of AIDS, the immune system is severely affected by HIV with a significant fall in CD4 cell count. Fungal infections are common in the third stage.”

HIV medications side effects

Skin rashes are the most common side effect of HIV drugs. According to the Office of AIDS Research, National Institutes of Health (NIH)website, “A rash due to an HIV medicine is often not serious and goes away in several days to weeks without treatment. But sometimes when an HIV medicine is causing a rash, it may be necessary to switch to another HIV medicine. In rare cases, a rash caused by an HIV medicine can be a sign of a serious, life-threatening condition.”

In some cases, people develop a serious, hypersensitive drug reaction called Stevens-Johnson syndrome. As a serious allergic reaction to a medicine, a hypersensitive reaction can be life-threatening and requires immediate medical attention. The majority of the rashes caused by HIV medications are treatable, taking antiviral medication keeps viral levels low and reduces HIV’s impact on the immune system.

Importance of early diagnosis

HIV is transmissible if a person comes in direct contact with the blood, semen, rectal fluids, vaginal fluids, and breast milk of an HIV-infected person. However, when it comes to skin infections related to HIV, not all are contagious. Dr TS informed, “Technically though all infectious skin conditions can spread from one person to another, it’s more often than not true that the skin conditions of HIV/AIDS patients are due to the weakened immune system and are limited in its transmission potential and the ability to cause symptomatic infection in normal healthy individuals.” Conditions like molluscum contagiosum and herpes infections may be passed from person to person through skin-to-skin contact.

The advent of highly active antiretroviral therapy (HAART) has changed the spectrum of skin disorders by improving host immunity. While the risk of death has been significantly reduced by the use of HAART, the quality of life for every patient is affected, so management of these complications such as skin conditions should not be overlooked. The treatment modalities differ depending on the skin condition. “With the increased availability of anti-HIV drugs, the prognosis for skin conditions associated with low CD4 counts are improving, as many will be resistant to optimal treatment without improved underlying immune function,” shared Dr Ashutosh Shukla, Medical Advisor and Senior Director – Internal Medicine, Max Hospital, Gurugram.

Depending on how weak the immune system is, skin infections in HIV-infected people may take longer to heal or require more extensive treatment. The most important is adherence to antiretroviral therapy consistently and as prescribed. Eating a nutritious diet, staying hydrated, getting enough rest, and exercising regularly can be helpful for a healthy immune system. It is important to practice proper sanitisation for safety. As the immune system gets better, complications reduce.